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Abstract

Three moral values are within the blood and organ donation with therapeutical purpose: giving without obligation, altruism and solidarity. It seems than for donors unselfishness is something transcendental: blood save lives. Altruism and solidarity are present, but spending is under the pattern of reciprocity. Recruiting and keeping blood and organ spenders is an uncertain and complex process. How spenders live reciprocity can help us to understand rejections to donation. The research work is based on personal interviews and on the analyses of the material used in recruitment actions of blood and organ donors. Two kinds of reciprocity were discovered: focused and fuzzy reciprocity (according to how the community is conceived and which is its target). Focused reciprocity is characteristic of social systems based on tight personal relationships. Fuzzy reciprocity is characteristic of individualistic and anonymity based societies. This is a main point in spending, thus focused reciprocity is not compatible with donations with therapeutical purpose which are voluntary, altruist and anonymous. That what obstruct donation is the restricted exchange due to focused reciprocity. Having a common blood relation o biological heritage is not a main basis to reject donation, as it could be thought.

Introduction

     Despite the continuous breakthroughs in biotechnology, artificial or biotechnological substitutes of blood, tissue and human organs (therapeutic products of human origin - TPHO) are still to be created. The dependence of health assistance on human donors results in a complex relation that goes beyond the traditional doctor/patient relationship. According to the World Health Organisation (WHO) guidelines on blood donation -which were adopted in 1948 during the XVII International Conference of the League of Red Cross Societies- ¹, TPHO donation is legally regulated in Spain on the basis of no remuneration. Its aim are (i) to guarantee people's universal rights with the inclusion of ethical clauses for the defense of personal integrity; (ii) to harmonize pharmacological interchange; (iii) to have the necessary legal mechanisms to avoid TPHO illegal international trade and to avoid the conflict generated by the coexistence of non-profit-making systems with commercial ones as well as the conflict between the public and private ones; (iv) to control the quality of human origin products for transfusion and transplant; and, above all, (vi) to guarantee that all people have access to health assistance on equal terms. It was then agreed that the donation of all PTOH is a voluntary, altruistic, free, non-profit-making and anonymous act.
     These aspects will be analysed through some interviews carried out between 1993 and 2004 to donors and through the analysis of campaigns for the recruitment of donors of the Transfusion Center of Galicia (CTG), the National Transplant Organisation (ONT) and the Spanish Federation of Blood Donors (Fedsang).
     The basic principle of donation is a prosocial behaviour -the way in which people contribute to the welfare of the others-². It seems than for donors unselfishness it is something transcendental, as showed on the slogan of the Fedsang: "With a little bit of you, you can save a lot of lives" (https://www.donantesdesangre.net/menu.htm). Altruism and solidarity are present, but from a structural point of view, donation is inside a reciprocity logic that turns the act of giving in an act with some implications that start in what it is done. The disinterested attitudes of donating do not prevent their consequences. The same way that to be altruist (and selfish), an agent on which the action falls is necessary, the action determines whether and how the "disinterested act" is going to take place. This is the contradictory character between altruism and selfish behaviour (towards oneself or towards other people), an example of it is the slogan of the National Transplant Organization: "Think of you. Become a donor", "The more donors there are, the more relaxed you, your family and thousands of people will feel. Because you all that do not need a transplant right now, may need it in the future". (https://www.msc.es/Diseno/informacionProfesional/profe-sional_trasplantes.htm).
     What is used as a way for recruiting donors (disinterested for the case of blood and interested in the case of organs and tissues) reflects marketing strategies but it also shows us the limits and paradox of the values speeches on donation are about, as well as its real implications.

The base of altruism and solidarity

     Altruism as well as solidarity, both implicit and explicit in the donation, respond to a prosocial behaviour that is characterised by the centrality of the strategic decision of the potential donor in response to the demand for help. More important than what it is strictly individual, this analysis takes the people, the situations and the social system as a starting point. Social pressure and informal control mechanisms play an important role as context of the decision: the origin of giving to others is confirmed as part of a sociocultural complex with effective rules and not only as a strictly autonomous act. The ways of prosocial behaviour are classified inside a system of social relations that reveals the limits of these behaviours. But the concept of prosocial behaviour must be explained according to four aspects:
     a) It is not only behaviour, but it is about the expression of a regulating social principle with a supraindividual logic, it is the behaviour of a community of people with a common and moral responsibility.
     b) The social pressure is an instrument of social cohesion, but it is not an autonomous regulator of the relations because there are latent structures in it that must be unravelled. We should also find out why the "social pressure" is effective and in which areas, which refers to another variable of social relations.
     c) The difficulties and consequences of initiating the prosocial behaviour are determined by specific kinds of previous agreements.
     d) Some prosocial behaviour is not determined by any concrete demand, but it is activated because of the implication of other people that were not involved at the beginning, that is, the behaviour creates the demand.
     It was thanks to Marcel Mauss³ that we know that giving goes beyond altruism, will and anonymity, up to interest, obligation and personal identity.^4-6 The question presented here is that the values of donation are not neutral (universal), nor univocal (free of conflict). The values of donation are influenced by an important actor (sanitary assistance  = medical practice + legal frames) that define the only protocols that apply to transfusion and transplant. It may result in conflict between the values defined by the normative frame and those generated inside the weak actors (donors and recipients) that are the object of these policies.
     Altruism and solidarity are the essence of the messages about donation (both at a professional and non professional level) because of the absence of the lucrative component and as part of an individual act morally neutral. But what is hidden behind that is the denial of the reciprocity component and the evidence that it takes place in specific contexts full of discriminated morality. When a "voluntary, altruist and anonymous donation" is required, it remains clear that it is not conditioned (as it is the familiar one), it is not paid (as synonymous with altruism) and it is universal (indiscriminated).
     There is a clear tendency in the donation campaigns towards the individualization of the donor and the recipient, which responds to the principle of freedom and individual responsibility: political principle of our social systems under the idea of citizen. But we also know, and it remains obvious in the case of donation, that the practice and shaping of the social life go beyond individual monadism. Interpersonal networks, mainly the familiar ones and other derived from them, are of great importance, mainly in the case of TPHO donations.^7-9 Health authorities should devote an important effort to something which escapes them: the reluctance to donate being a healthy person. Social marketing campaigns try, apart from spreading the need to donate, to neutralize the familiar or social context that may interfere in the decision of the donation. The tendency is that the will of the donor takes priority over that of the family. Just in the case of cadaverous donations, family approval is required. In practice, the kind of familiar responsibility towards the corpse together with the kind of death makes a big difference in the donation rates amongst countries ^10,11.
     Altruism, as well as solidarity, to which promotion campaigns turn to, present an isolated individual, out of social ties, without any kind of commitment that interfere the relationship with the sanitary system. The motto of the CTG shows this idea: "Solidarity is inside you", just wait for people to let it come out. The altruist person is an individual of unlimited commitment with the sanitary system, because it is just through individualization that useful bodies can be used. But it is not about the unselfish giving, but about "you can do the same for me one day" that leads to a responsibility in which the act of giving implies the responsibility of the one who gives and it also closes the cycle of reciprocity under which the one who gives is a potential recipient.
     What firstly seems a resort used by social marketing, gets more important because without being necessarily explained, it has the latent logic of giving: the person who gives becomes a potential recipient and, who receives? The basis of our social system, made up according to the individual rights and duties, makes that sanitary assistance breaks the logic of reciprocity. If I have given, when am I going to receive? Why am I going to give if I will never need a kidney? Even when there is a low probability that a donor becomes the recipient, what is exchanged in sanitary assistance is the possibility that the service can be guaranteed in all kind of ailments and cases. That is also the principle of reciprocity (that in many occasions seems to be forgotten by the individuals responsible for sanitary matters), what is done is never returned, but something equivalent is given¹².
     Altruism and solidarity create a strange link that is aimed at the others and that does not die at the moment of giving. Far from being the culmination of an individual or private act, it is mainly a social and public act. The person who gives not to receive cause the sublimation of the act, that far from cancelling reciprocity, promotes other ways of return in which confidence, prestige, pleasure and gratitude take priority.
     Social unity, as a degree of intensity of the relationships created in a community by sharing interests that can be achieved by turning to other actors we trust, is parallel to the reciprocity that is generated. The existence of signs of reciprocity gives the idea that the way of selfish satisfaction "I give because it is going to be returned" does not sully the principle that defines it. But it is extremely risky to justify the decision of donating in just one of the multiple aspects that come into play. Moral satisfaction (what is immediately returned to you) and the altruist action are other components of the mechanism of reciprocity.

Ways of reciprocity

     The way in which reciprocity is activated, the areas delimited by it, the social spheres still regulated by reciprocity and the ones in which there is a conflict with the institutional conception are the keys to discover the way in which we act in connection with the donation of TPHO. Despite the purpose of (re)producing a conception of articulated donation in individualistic altruism, the persistence of other implicit ways of reciprocity makes it possible for maternal and paternal love, mutual help or charity to emerge. These aspects are difficult to assimilate by the new culture of donation.
     Attention to this context makes it possible to highlight the importance of the two ways of reciprocity (focused and fuzzy) for the social system. The reciprocity ties that are activated and the ones which are not, the importance of commitment of the tie and the cause of the activation are complex and have a lot to do with the networks of relationships between the members that make up a social group.
     Love and the satisfaction of helping that are present in the middle of the constitution of a community with strong ties should also be taken into account. This one focuses on the establishment of really strong interpersonal ties that are placed on top other ways of regulation of the social life, such as the institutional ones. What really makes a qualitative difference in this sense is the establishment of networks of interpersonal relationships that remain limited to specific groups of people: to those made up of personally identifiable relationships.
     In order to deal with this duality, we are going to define these two kinds of reciprocity that respond to the same logic but that imply different ways of social performance and perception.
     "Focused reciprocity" constitutes the way of interaction established between people identified in a definite social network where each person has a vital story and has a specific position: they can be identified. A consequence of great significance of this conception with regard to reciprocity is that it is currently in force because it is the main mechanism of constitution of these communities. It is called focused because it requires a point of attention that can be easily identified.
     "Fuzzy reciprocity" represents a sort of anonymous exchange in which the one who gives and the one who receives can be anyone. This reciprocity, which considers the fact of giving back as a moral commitment, does not apply to all people but it applies to a community that is not determined by personal relationships. In the case of the PTOH donation, it is defined according to the remit of the department of transfusion or transplant, that means, if the aim is that all people donate for all people, in practice, the objective is that these included inside the remit of that unit or department of donation are considered as part of the community.
     The limitation of one or the other reciprocity depends on the number of people in action and mainly on the availability for the others. The main difference lies in the demand for reciprocity, that in the case of the focused one could only be satisfied by the own restricted community (in extent and intensity) and that in the case of fuzzy reciprocity makes it possible for the institutions to regulate this exchange, to guarantee that it is going to be a fact and to carry it out, in this case, in health centers.

Closure and certainty

     The degree of "occidentalization" in the Chinese community in programs of blood donation^13,14 was measured in two studies. By using a scale of twenty items of medicinal customs and beliefs, we found out that there was a clear relation with other variables such as the level of education and the use of the Chinese as domestic language. Acting cautiously, the results of this research give us a clue: there is a direct correlation between the degree of occidentalization and a higher participation in the donation campaigns.
     What do we understand by occidentalization in the medical field? The level of confidence in the health system is overlapped by the quality of the assistance but also by the establishment of the civilized body¹⁵. Confidence is activated when the person transfer to another person the control of the health of the body, becoming the governor in another dimension, because the transfusion and the transplant are not possible out of the biomedical (and legal) field.
     The act of donation comes together with fear that responds to different aspects that emerge as suspicion at any time. It goes from the pain threat to possible side effects. Is a person dead if his organ still lives in another person? The answer to this and other questions can only be found thanks to the personal experience and the confidence placed in the health system.
     In low institutional confidence systems, the ways of focused solidarity also take priority over those of fuzzy solidarity in which the possibility of supervision based on a personal identification in which reciprocity and confidence mechanisms merge, is also considered. It also happens when the demand seems to be unquestionable, as it is the case of massive donations, after a specific case appears in the media, or after the hope of a virtual community is kept alive.
     The questions we are going to deal with are the followings: In which cultural conceptions does the family become the special group (even in situations of loss of the traditional ways of sociality, the family represents an idealized referent)? How is the barrier of this preference established when someone decides to give to someone different from this immediate group? The ways of expressing where this point of inflection is located, the sentence "when someone really needs it" determines donation.
     It is about the resistance or not to put in circulation elements (own TPHO or of a relative who has died) that leave a door open to ways of exchange and reciprocity that cannot be under control (because they depend on a third element: the health system and the reason why there is no general confidence in its performance) and that could also destabilize or threaten the closure and the group identity.

The weakness of the blood bond

     "Giving blood" for their family and friends is a precise expression when talking about blood donation (we should bear in mind that there is blood in every organ) but it does not lie in the existence of a blood bond; it is justified because of familiar ties and motherly and fatherly love. In the case of blood, it is easily linked to a biological and genealogical tie, whereas in organ donation, the image of unlimited love prevails. We also consider that in the case of blood there is also a social tie marked by reciprocity and love.
     We talk about the family as a limited group in which there is a unique cohesion when compared to any other social group. The family is ideally defined as a closed system or as a system that is different because of a blood bond. The degree of proximity or remoteness relative to a common biological origin is useful to establish the limits of the family, degrees of relationship according to the idea of the nuclear family. It means that within the limits of the family, the element of closure is attributed to a line marked by blood purity with respect to foundational blood. The family is constituted by a pyramid in which every step means a level of mixture or remoteness with respect to the blood of the parents; with every generation, this pyramid opens in the shape of a fan amongst siblings and so on until composing a succession of pyramids joined by their original vertex.
     The key of the familiar systems lies in ancestry, not in the descendants.¹⁶ Familiar blood bonds are not due to an heritage shared by all the members (specially common blood), but the biological continuity that partially defines the limits of the familiar blood group lies in a common origin. Therefore, blood acts as the basis of the filiation relationships but it does not exist between the mother and the father. In Classical times as well as in the Middle Ages, the semen was thought to be a blood transmutation (in accordance with Hippocratic theories), therefore, "having the same blood" refers to that common origin, to that semen of the same father. Apart from blood proximity, there is another relational one that has to do with "having someone in common". Group closure is not done towards an external frontier (different blood) but towards a common central point of cohesion and control of the group limits. If the role played by blood can be relativized, the characteristic nucleus of the familiar relationships is not exclusively related to blood. The symbol of the kinship relationships lies in the principle of solidarity that emerges from the familiar bond.
     In relation to that, we should consider the donation of TPHO as a valuable exchange, mainly in relation to the principle of universality, because of the treatment of the blood taken, that after undergoing a biomedicalization -it stops flowing around the body to be extracted- and pharmaceuticalization process - is treated in the laboratory to become a therapeutic product which will be kept- and it loses any possibility to imply a blood bond or a bond of identification of the donor. The taboo about blood is not radical; firstly, because it does not exist or because it is too weak and secondly, because the basis of this contamination does not lie in the biochemical composition or in the value of blood filiation, but in the own constitution of closure exchange (towards other groups or towards what is private).

References

1. Organización Mundial de la Salud. Gestión de servicios de transfusión de sangre. Ginebra: Organización Mundial de la Salud,1991.
2. Montada L, Bierhoff HW. Studying Prosocial Behavior in Social Systems. En: Montada L, Bierhoff HW, editores. Altruism in Social Systems. Lewiston: Hogrefe & Huber Publishers, 1991:153-163.
3. Mauss M. Ensayo sobre los dones. Motivo y forma del cambio en las sociedades primitivas. Sociología y antropología. Madrid: Editorial Tecnos, 1991.
4. Chacón F. Variables socioculturales en donantes de sangre. Psicología social de los problemas sociales. Actas del Primer Congreso Nacional de Psicología Social; 1985 sep;3-7. Granada: Universidad de Granada, 1988;365-367.
5. INRA. Eurobarometer 41.0. Europeans and Blood. Bruselas: Comisión Europea, 1995.
6. Ministerio de Sanidad y Consumo. Estudio de actitudes de la población ante la donación altruista de sangre. Madrid: Ministerio de Sanidad y Consumo, 1990.
7. Fellner CH, Marshall JR. The myth of informed consent. American Journal of Psychiatry, 1970; 126(9):1245-1251.
8. Fellner CH, Marshall JR. Kidney Donors Revisited. En: Rushton JP-Sorrentino RM. editores. Altruism and helping behavior. Social, Personality, and Development Perspectives. Hillsdale (New Jersey): Lawrence Erlbaum Associates, 1991;351-365.
9. Sáez F. Por un hijo se da todo: un riñón, el hígado. Magazine El Mundo (Mad) 2003; 23 de marzo. Disponible en: <https://www.el-mundo.es/magazine/2003/182/1048265564.html> [Consultado el 17.8.2004]
10. Baxter D. Beyond Comparison: Canada's Organ Donation Rates in an International Context. Vancouver: The Urban Futures Institute, 2001.
11. Schneider W. Death is not the same always and everywhere. Sociocultural aspects of brain death and the legislation of organ transplantation. The case of Germany. European Societies, 1999; 1(3):353-389.
12. Casado-Neira D. La teoría clásica del don en el análisis de la donación de sangre. Revista Internacional de Sociología, 2003; 34:107-133.
13. Gould-Martin K, Ngin C. Chinese Americans. En: Harwood A. editor. Ethnicity and medical care. Cambridge: Harvard University Press, 1981;130-171.
14. Lih-Yea G, Wiesenthal DL, Weizmann F. Blood donation in the chinese community. 22nd International Congress of Applied Psychology 'Proceedings - Social educational and Clinical Psycology' (3), 1990 jul;22-27. Kyoto: Hove: Lawrence Erlbaum Associates, 1992:380-381.
15. Turner BR. Regulating Bodies. Essays in Medical Sociology. London: Routledge, 1992.
16. Bestard J. Parentesco y modernidad. Barcelona: Paidós, 1998. 

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